Rush for health options before Jan. 1

If people whose health insurance was canceled under Obamacare this year don’t line up new coverage this month, the Obama administration could face a political nightmare. More people could have lost coverage than gained it when the health law benefits begin on Jan. 1.

That’s by no means a certainty; the sign-up website is doing better, some insurance carriers are extending plans instead of canceling them, and there are millions more uninsured people who stand to get covered than there are covered people facing plan cancellations. Medicaid sign-ups are also running strong.

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Still, the estimated 4 million to 5 million — there are no official numbers, just industry guesstimates — getting plan cancellation notices have had a giant media megaphone, a Republican chorus and a story to tell about how President Barack Obama broke a promise that if they liked their health plans, they could keep them. And some of them need to get new coverage before the first of year.

That’s put a lot of pressure on closing that potential coverage gap by Dec. 23, the last day people can sign up for Obamacare coverage that starts Jan. 1. Here are some of the options for people facing plan cancellations.

Shop on the exchanges

This was the Obama administration’s preferred solution all along, but it was extraordinarily difficult for the past two months in the 36 states that depend on HealthCare.gov and in a handful of state exchanges like Oregon that have tech problems of their own.

That amplified the political backlash from the wave of cancellation letters. People losing their plans couldn’t check out their options — or find out if they could get a subsidy, in some cases worth thousands of dollars.

“It was unbelievably frustrating,” said Michael McGrath, a self-employed Illinois man who said the policy for his wife and three children was canceled. “The website didn’t work at all — it was the perfect evidence for people who say the public sector can’t do anything like this. And we really did not know what we could do.” In a conversation early this week, the family was still trying to figure it out.

Republicans are curating stories of people gobsmacked by cancellations, which often come with offers of an alternative, Obamacare-compliant policy that is considerably more expensive because it includes richer benefits and is available to the sick as well as the well.

Independent Women’s Voices, a group that opposes Obamacare, launched a website — mycancellation.com, that has gathered hundreds of pictures of cancellation letters. “You can’t deny the real-life experience of people who receive a letter in the mail that says you can’t keep your plan because of the Affordable Care Act,” said the group’s senior policy analyst Heather Hadley.

But now consumers are flocking to the website in droves. More than 2 million visited and 29,000 chose health plans in two days this week. That pace is not nearly adequate to cover everyone who got a cancellation notice, but it may pick up as the website improves and the sign-up deadline approaches.

What people see when they get online will vary widely, based on where they live, how much they make and their age. Many will qualify for federal subsidies available to people with incomes up to four times the poverty rate — or about $94,000 for a family of four in 2013.

But some people will pay more for Obamacare-required benefits that they don’t want or will have plans that both cost more and have higher out-of-pocket costs. Beneficiaries may also have fewer choices of hospitals and doctors, which means people losing existing coverage may have to change doctors.

“More comprehensive plans that allow more sick people to sign up for them are going to cost more money,” said Tim Jost, an expert on the Affordable Care Act and a professor at Washington and Lee University.

The cancellation fix

Plans that are canceled don’t necessarily have to stay canceled.

Obama three weeks ago offered a rare presidential mea culpa for the botched rollout and vowed to make good on his broken promise: “If you like your plan, you can keep it.” He announced that he would waive Obamacare rules so that state regulators and insurance companies could let people keep their plans through next year. But the ultimate decision is not Obama’s to make. State officials and the insurance companies had to go along with the suggestion. The uptake has been decidedly mixed.

So far, roughly 20 states have OK’d the extension policy, about another 20 have declined, and nine remain undecided, according to America’s Health Insurance Plans, an industry trade group. But even in states that allowed extensions, insurers still have to decide whether to offer the plans in 2014. A few plans, like Blue Cross in Florida and South Carolina, have said they’ll offer renewals. But overall, nationally there are no firm figures on how many health insurers will offer this option or how many people will take it.

Keeping the same policy doesn’t mean keeping the same price. It can go up significantly, as the McGrath family learned when it received an offer to renew after Obama announced the policy change.

“It’s about $90 more per month, but I won’t attribute that all to the [health] law. It goes up every year,” McGrath said.

The reprieve would be only for a year — meaning there would be more waves of cancellations.

Some insurers also have given customers the option to “early renew” their plans, locking in the same policy into 2014. Colorado Commissioner of Insurance Marguerite Salazar said this week that more than 95 percent of state residents hit with the cancellation notices this year were allowed to renew their policies into 2014. Those policies can’t be sold after Jan. 1, when new benefit requirements take effect, but they can be sold now and continued into next year.